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A look at appropriate handling of failed proximal femoral fracture fixation
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ORLANDO, Fla. — During a session on hip fractures at the Current Concepts in Joint Replacement Winter Meeting, here, William J. Hozack, MD, shared his insights and recommendations for salvage options after failed fixation of proximal femoral fractures.
While many clinicians may not deal with these fractures on a day-to-day basis in their practices, Hozack said “…open reduction and internal fixation does not always work and you need to be able to deal with it if it does not work.”
Infection should always be looked out for in these types of cases, Hozack noted, especially when nonunion or early failure occurred. Since these surgeries are not typically done on an emergency basis, such factors as a patient’s nutritional and smoking status can be planned for in advance to ensure the optimum outcome.
Standard extensile approaches are the recommended method to address failed fixation of proximal femoral fractures. Hardware removal is also essential with planning for broken screws or special hardware being of particular help and way to simplify the process, according to Hozack.
While Hozack noted mobile-bearing hip prostheses were a possible option, his clear preference (save for younger patient populations) is total hip arthroplasty with cemented or cementless stems. Hemiarthroplasty was not among Hozack’s preferred fixation methods due its significant risk of reoperation should more complete pain relief be needed.
“Conversion of failed fixation of proximal femoral fractures requires appropriate equipment and planning,” Hozack said. “Considerations are, for the most part, the same regardless of fracture type, but you can expect an interochanteric fracture to have a higher complication rate and require revision stems more often.” – by Christian Ingram
Reference:
Hozack WJ. Paper #16. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 9-12, 2015; Orlando, Fla.
Disclosure: Hozack reports he receives consultant fees, royalties and research support from Stryker.